JP5878014B2 - Instrument for internal fixation of bone fragments of rib fractures - Google Patents

Instrument for internal fixation of bone fragments of rib fractures Download PDF

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JP5878014B2
JP5878014B2 JP2011516222A JP2011516222A JP5878014B2 JP 5878014 B2 JP5878014 B2 JP 5878014B2 JP 2011516222 A JP2011516222 A JP 2011516222A JP 2011516222 A JP2011516222 A JP 2011516222A JP 5878014 B2 JP5878014 B2 JP 5878014B2
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ハンソン，ヘンリク
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スウェマック・イノベーション・アクチボラグ
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
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Description

本発明は、橈骨骨折部の骨片を内固定するための器具に関する。   The present invention relates to an instrument for internally fixing a bone fragment of a rib fracture.

本器具は、橈骨骨折部の骨片に隣接させる（ａｂｕｔｍｅｎｔ）少なくとも１つの本体と、前記骨片を固定するために本体にロックされることが意図される固定要素とを含む。前記器具の本体は、固定要素用の少なくとも２つの予め穿設された穴を遠位端部に有し、固定要素用の少なくとも２つの予め穿設された穴を近位端部に有する。   The instrument includes at least one body that abuts the bone fragment of the rib fracture and a fixation element that is intended to be locked to the body to secure the bone fragment. The body of the instrument has at least two pre-drilled holes for the fixation element at the distal end and at least two pre-drilled holes for the fixation element at the proximal end.

橈骨骨折の治療は、傷害の頻度及びその治療の難しさから問題であった。治療の目的は、関節の適合性及び解剖学的形態を回復させ、関節炎のリスクを最小限に抑え、関節の可動性を最大にすることである。   The treatment of rib fractures has been problematic due to the frequency of injury and the difficulty of treating it. The purpose of treatment is to restore joint compatibility and anatomy, minimize the risk of arthritis, and maximize joint mobility.

現在、橈骨骨折を治療するには複数の選択肢がある。   There are currently several options for treating rib fractures.

非観血的整復では、折れた骨を徒手で整復又は調整し、ギプス包帯を腕に付ける。これは、手術に関係する創傷を防ぎ、ケアシステムにとってより経済的である。しかし、骨片が治癒されるまでギプスにより動かすことができず、手首及び前腕のみに限定されないかなりの硬直を生じ得る。動けなくされた腕はしばしば高齢者の指、肘、及び肩にかなりの硬直を生じさせる。また、この技術は、最も単純で最も安定な骨折パターンに限定される。   In noninvasive reduction, the broken bone is reduced or adjusted manually, and a cast bandage is attached to the arm. This prevents surgery-related wounds and is more economical for the care system. However, it cannot be moved by the cast until the bone fragment is healed, which can result in considerable stiffness that is not limited to just the wrist and forearm. Stuck arms often cause considerable stiffness in the elderly's fingers, elbows, and shoulders. This technique is also limited to the simplest and most stable fracture pattern.

外固定では、指の中手骨中及び骨折部の上の橈骨中に挿入される比較的直径の大きなピンを使用する。その後、ピンはロッド又はフレームに連結される。通常、手の中に２つのピンが設置され、橈骨中にも２つのピンが設置される。骨折の整復を維持する目的で手首を牽引して離すために、フレームも用いられ得る。外固定には、フレームにより手首及び手が固定され、皮膚を貫通するピンが腱を刺激して瘢痕を生じさせやすいという欠点がある。これらの問題点が合わさって、手首及び指の両方においてかなりの硬直が生じ、把持機能が消失するか損なわれる。感染症も起こり得る。外固定は、骨片の解剖学的整復をもたらさない。外固定は、重度の粉砕された粉砕骨折で主に用いられる。   External fixation uses relatively large diameter pins that are inserted into the metacarpal bone of the finger and into the ribs above the fracture. The pin is then connected to the rod or frame. Usually, two pins are placed in the hand and two pins are also placed in the ribs. A frame can also be used to pull and release the wrist to maintain fracture reduction. The external fixation has the disadvantage that the wrist and hand are fixed by the frame, and the pin that penetrates the skin tends to irritate the tendon and cause scarring. Together, these problems result in considerable stiffness on both the wrist and fingers, and the grip function is lost or impaired. Infections can also occur. External fixation does not result in anatomical reduction of the bone fragment. External fixation is mainly used with severely crushed fractures.

観血的整復では、手首の上で切開し、骨片を整復し、必要に応じてプレート、スクリュー、又はピンを使用する。観血的整復及び内固定は橈骨骨折では一般的に用いられない。腱の瘢痕化、摩擦、及び硬直のリスクがある。骨片への血液供給が妨げられることがあり、それにより骨片が一緒に成長することが遅延又は事実上阻害され得る。小さくて脆弱な骨片中に穿孔してスクリューを螺挿すると、しばしば、骨片が更に断片化され、その結果、解剖学的整復が更に妨害される。通常の橈骨骨折におけるほとんどの骨片及び転位は背側に位置し、この領域における橈骨の不規則性と、背側の骨の近くには多くの腱が位置することから、背側にプレート及びスクリューを設置することは望ましくない。骨折には通常、整復される必要のある複数の小さな断片が含まれるので、プレート及びスクリューを用いた固定による処置は困難である。   In open reduction, an incision is made on the wrist, the bone fragment is reduced, and plates, screws, or pins are used as needed. Open reduction and internal fixation are not commonly used in rib fractures. There is a risk of tendon scarring, friction and stiffness. Blood supply to the bone fragments may be hindered, thereby delaying or effectively preventing the bone fragments from growing together. Drilling into a small and brittle bone piece and screwing in the screw often results in further fragmentation of the bone fragment, which further impedes anatomical reduction. Most bone fragments and dislocations in normal rib fractures are located on the dorsal side, and the irregularities of the ribs in this area and the presence of many tendons near the dorsal bone, It is not desirable to install a screw. Fractures usually contain multiple small pieces that need to be reduced, so treatment by fixation with plates and screws is difficult.

経皮ピンニングでは、骨折断片を貫通する小さな剛性ピンを設置する。ピンは、ラジオグラフィー下で皮膚を通して直接挿入され得る。経皮ピンニング、すなわち限定的な観血的技術を用いると、骨折をギプス包帯だけで処置した場合には達成されない内部での特定の更なる安定性を有する骨折の内固定が得られる。骨片は多くの場合小さく、骨が脆弱なので、固定には、直径の小さいピンがスクリューより適している。しかし、ピンを留めるためには骨片に近接する安定な骨が必要である。安定な骨片が、ピンニングすべき骨片からある程度距離があって、骨片に対する角度がずれている場合、ピンが屈曲又は転位し得るという大きなリスクがある。別の問題は、多くの場合、ピンを留めるための安定な骨要素がないことである。屈曲又は転位し易いピンを使用するということは、ピンニングはギプス包帯なしではほとんど行われないことをも意味している。   In percutaneous pinning, a small rigid pin that penetrates the fracture piece is placed. The pins can be inserted directly through the skin under radiography. Using percutaneous pinning, a limited open technique, results in fracture internal fixation with certain additional internal stability that is not achieved when the fracture is treated with a cast bandage alone. Because bone fragments are often small and bones are fragile, pins with a small diameter are better suited for fixation than screws. However, a stable bone close to the bone fragment is required to pin the pin. If a stable bone fragment is at some distance from the bone fragment to be pinned and is at an angle to the bone fragment, there is a great risk that the pin may bend or displace. Another problem is often the lack of a stable bone element for pinning. The use of pins that tend to bend or displace also means that pinning is rarely performed without a cast bandage.

本発明の目的は、橈骨骨折部の骨片の効果的且つ最適な内固定を可能にする器具を提案することである。   The object of the present invention is to propose a device which allows an effective and optimal internal fixation of the bone fragment of the rib fracture.

この目的は、導入部で定義する器具によって達成される。本体を橈骨骨折部の骨片に隣接させた後に本体の遠位端部及び近位端部の穴を介して前記骨片に挿入される全ての固定要素が本体の横断方向から見て橈骨骨折部を横切るように、器具本体の予め穿設された穴は本体の長手軸に対して斜めに空いている。前記器具中の各固定要素は、橈骨骨折部の骨片中に固定要素をロックするため及び本体に固定要素をロックするための、少なくとも１つの固定部を有する。   This object is achieved by the instrument defined in the introduction. All fixation elements inserted into the bone fragment through holes in the distal end and proximal end of the main body after the main body is adjacent to the bone fragment of the radial fracture portion are fractured when viewed from the transverse direction of the main body. The pre-drilled hole of the instrument body is open obliquely with respect to the longitudinal axis of the body so as to cross the part. Each anchoring element in the instrument has at least one anchoring part for locking the anchoring element in the bone fragment of the radius fracture and for locking the anchoring element to the body.

したがって、本発明に係る器具は、適用が容易な少数の部品を含む。１又は２ヶ所の非常に短い切開部を用いた外科手術の実施が容易になり、器具は、橈骨骨折部が非常に安定して固定されるような固定要素の設置ができるように構成されている。   Thus, the device according to the present invention comprises a small number of parts that are easy to apply. Facilitates performing surgery with one or two very short incisions, and the instrument is configured to allow the placement of a fixation element that allows the rib fracture to be fixed very stably Yes.

本発明に係る器具の有利な更なる実施の形態を従属請求項に定義する。   Advantageous further embodiments of the device according to the invention are defined in the dependent claims.

本発明のその他の目的及び利点は、添付の図面及び本発明の好ましい実施形態についての以下の詳細な説明を吟味すれば、当業者に明らかであろう。   Other objects and advantages of the present invention will become apparent to those skilled in the art upon examination of the accompanying drawings and the following detailed description of the preferred embodiments of the present invention.

本発明に係る器具の一部を形成する、実質的にプレート様をした本体の第１の実施の形態の斜視図である。1 is a perspective view of a first embodiment of a substantially plate-like body forming part of an instrument according to the present invention. FIG. 本発明に係る器具の一部を形成する、実質的にプレート様をした本体の第１の実施の形態の斜視図である。1 is a perspective view of a first embodiment of a substantially plate-like body forming part of an instrument according to the present invention. FIG. 本発明に係る器具の一部を形成する固定要素が挿入された図１及び２の実質的にプレート様をした本体を種々の観点から示した図である。FIG. 3 shows the substantially plate-like body of FIGS. 1 and 2 from various points of view with the fastening elements forming part of the device according to the invention inserted. 本発明に係る器具の一部を形成する固定要素が挿入された図１及び２の実質的にプレート様をした本体を種々の観点から示した図である。FIG. 3 shows the substantially plate-like body of FIGS. 1 and 2 from various points of view with the fastening elements forming part of the device according to the invention inserted. 本発明に係る器具の一部を形成する固定要素が挿入された図１及び２の実質的にプレート様をした本体を種々の観点から示した図である。FIG. 3 shows the substantially plate-like body of FIGS. 1 and 2 from various points of view with the fastening elements forming part of the device according to the invention inserted. 本発明に係る器具の一部を形成する固定要素が挿入された図１及び２の実質的にプレート様をした本体を種々の観点から示した図である。FIG. 3 shows the substantially plate-like body of FIGS. 1 and 2 from various points of view with the fastening elements forming part of the device according to the invention inserted. 本発明に係る器具の一部を形成する固定要素が挿入された図１及び２の実質的にプレート様をした本体を種々の観点から示した図である。FIG. 3 shows the substantially plate-like body of FIGS. 1 and 2 from various points of view with the fastening elements forming part of the device according to the invention inserted. 橈骨骨折に取り付けられた後の本発明に係る器具を模式的側面図で示した図である。It is the figure which showed the instrument which concerns on this invention after being attached to a rib fracture with the typical side view. 固定要素が挿入された実質的にプレート様をした本体の近位端部の拡大切断図である。FIG. 5 is an enlarged cut-away view of the proximal end of a substantially plate-like body with a fixation element inserted. 本発明に係る器具の一部を形成する実質的にプレート様をした本体の第２の実施の形態の斜視図である。FIG. 6 is a perspective view of a second embodiment of a substantially plate-like body forming part of the instrument according to the present invention. 本発明に係る器具の一部を形成する実質的にプレート様をした本体の第２の実施の形態の斜視図である。FIG. 6 is a perspective view of a second embodiment of a substantially plate-like body forming part of the instrument according to the present invention.

橈骨骨折部の骨片を内固定するための本発明に係る器具は、既に示したように、橈骨５の骨折部４の骨片２及び３に隣接させる少なくとも１つの本体１、並びに前記骨片を固定するために本体にロックすることが意図される固定要素６及び７を含む。   The instrument according to the present invention for internally fixing the bone fragment of the rib fracture part, as already indicated, at least one body 1 adjacent to the bone fragments 2 and 3 of the fracture part 4 of the rib 5 and the bone fragment It includes fixing elements 6 and 7 that are intended to be locked to the body in order to fix.

本体１は、意図した用途に最も適した細長い実質的にプレート様の形状及びサイズをしている。本体１は有利には、橈骨４の形状に対応して長手方向に湾曲した形状を有する。所望であれば、本体１は、それぞれ右手及び左手に特に適するように構成され得、種々の長さで作製され得る。本体１はまた、目的に適した任意の厚さ、例えば約２ｍｍ又は約３ｍｍ（ぞれぞれ図１０及び１１並びに図１〜９）で作製され得る。本体１はポリエチレン製、例えばＵＨＭＷＰＥ（超高分子量ポリエチレン）製であってよく、これは、摩擦的ロックによって本体への固体要素６、７の効果的ロックに貢献するためであり、また、この材料がラジオグラフィーに対して透過性であるためである。本体は低重量である（指示した材料で作製された場合、約１５ｇ）。しかし、目的に所望される特性を有するのであれば、その他の材料、例えば金属又は金属合金も関連し得る。   The body 1 has an elongated, substantially plate-like shape and size that is best suited for the intended application. The body 1 advantageously has a shape curved in the longitudinal direction corresponding to the shape of the ribs 4. If desired, the body 1 can be configured to be particularly suitable for the right hand and left hand, respectively, and can be made in various lengths. The body 1 can also be made in any thickness suitable for the purpose, for example about 2 mm or about 3 mm (FIGS. 10 and 11 and FIGS. 1-9, respectively). The body 1 may be made of polyethylene, for example UHMWPE (ultra high molecular weight polyethylene), because it contributes to the effective locking of the solid elements 6, 7 to the body by frictional locking, and this material Is transparent to radiography. The body is low weight (about 15 g when made with the indicated materials). However, other materials, such as metals or metal alloys, may be relevant as long as they have the desired properties for the purpose.

本発明によれば、細長い本体１は、固定要素６用に少なくとも２つの予め穿設された穴８を遠位端部１ａに有し、固定要素７用に少なくとも２つ、図示した実施の形態では３つの、予め穿設された穴９を近位端部１ｂに有する。本発明によれば、本体を橈骨骨折部４の骨片２、３に隣接させた後にそれぞれ本体の遠位部端１ａ及び近位端部１ｂにある穴８及び９を介して前記骨片に挿入されるそれぞれ固定要素６及び７の全てが本体の横断方向から見て前記橈骨骨折部４を横切るように、予め穿設された穴８、９は本体１の長手軸Ｌに対して斜めに空いている（図４）。その結果、橈骨骨折部４の固定が非常に安定する。   According to the invention, the elongate body 1 has at least two pre-drilled holes 8 in the distal end 1a for the fixing element 6 and at least two for the fixing element 7, the illustrated embodiment. Now have three pre-drilled holes 9 in the proximal end 1b. According to the present invention, after the main body is adjacent to the bone fragments 2 and 3 of the rib fracture portion 4, the bone fragments are inserted into the bone fragments via holes 8 and 9 in the distal end 1 a and the proximal end 1 b of the main body, respectively. The pre-drilled holes 8 and 9 are inclined with respect to the longitudinal axis L of the main body 1 so that all the fixing elements 6 and 7 to be inserted cross the rib fracture part 4 when viewed from the transverse direction of the main body. It is vacant (Figure 4). As a result, fixation of the rib fracture 4 is very stable.

好ましくは、遠位固定要素６の少なくとも１つ及び近位固定要素７の少なくとも１つは、橈骨骨折部４の略中心を横切る（図８参照）。   Preferably, at least one of the distal fixation elements 6 and at least one of the proximal fixation elements 7 traverse approximately the center of the rib fracture 4 (see FIG. 8).

予め穿設された穴８、９は、必要に応じて、また所望により、本体１の長手軸Ｌに関して同じ、又は実質的に同じ、又は異なる角度で斜めに空いていてよい。本体１の遠位端部１ａの予め穿設された穴８が本体の長手軸Ｌに対して略４５°の角度で斜めに空いており、本体の近位端部１ｂの予め穿設された穴９が本体の長手軸に対して約４５〜６０°、略４５〜５０°の角度で斜めに空いている時、良好な固定結果が得られる。したがって、それぞれ端部１ａ、１ｂの予め穿設された穴８及び９は、これも好ましいものであるが、本体の横断方向から見て互いに略平行に空いている。したがって、各端部１ａ、１ｂの固定要素６、７も、本体の横断方向から見て、互いに平行に延びる。   The pre-drilled holes 8, 9 may be open obliquely at the same, substantially the same or different angles with respect to the longitudinal axis L of the body 1 as required and desired. A pre-drilled hole 8 in the distal end 1a of the main body 1 is obliquely inclined at an angle of about 45 ° with respect to the longitudinal axis L of the main body, and a pre-drilled hole in the proximal end 1b of the main body 1 is formed. Good fixing results are obtained when the holes 9 are open at an angle of about 45-60 °, approximately 45-50 ° with respect to the longitudinal axis of the body. Accordingly, the pre-drilled holes 8 and 9 in the end portions 1a and 1b, respectively, are also preferable, but are substantially parallel to each other when viewed from the transverse direction of the main body. Accordingly, the fixing elements 6 and 7 at the ends 1a and 1b also extend in parallel with each other when viewed from the transverse direction of the main body.

本発明によれば、利点のある予め穿設された穴８、９も、本体の遠位端部１ａの穴８を介して挿入される固定要素６が本体の近位端部１ｂの穴９を介して挿入される固定要素７と交差するように、本体１の長手軸Ｌに対して斜めに空いている。   According to the invention, the advantageous pre-drilled holes 8, 9 are also inserted into the holes 9 in the proximal end 1 b of the body by the fixing element 6 inserted through the holes 8 in the distal end 1 a of the body. It is vacant obliquely with respect to the longitudinal axis L of the main body 1 so as to intersect with the fixing element 7 inserted through the main body 1.

本発明に係る器具の図面に示した第１の実施の形態によれば、本体１の近位端部１ｂの予め穿設された穴９を介して挿入される固定要素７が本体の長手方向から見て実質的に本体の長手方向を向く実質的に共通する平面中に位置するように、予め穿設された穴９は本体の長手軸Ｌに対して斜めに空いている（好ましくは、図３〜７参照）。   According to the first embodiment shown in the drawing of the instrument according to the invention, the fixing element 7 inserted through a pre-drilled hole 9 in the proximal end 1b of the main body 1 is in the longitudinal direction of the main body. The pre-drilled holes 9 are open obliquely with respect to the longitudinal axis L of the main body (preferably, so as to be located in a substantially common plane facing the longitudinal direction of the main body as viewed from See FIGS.

それに対応して、同じ実施の形態によれば、本体１の遠位端部１ａの予め穿設された穴８を介して挿入される固定要素６が本体の長手方向から見て異なる平面中に位置するように、予め穿設された穴８は本体の長手軸Ｌに対して斜めに空いている（図３〜７）。   Correspondingly, according to the same embodiment, the fixing element 6 inserted through the pre-drilled hole 8 in the distal end 1a of the body 1 is in a different plane as viewed from the longitudinal direction of the body. The pre-drilled hole 8 is formed obliquely with respect to the longitudinal axis L of the main body so as to be positioned (FIGS. 3 to 7).

したがって、遠位固定要素６は、近位固定要素７を含む平面に対して、角度をなして延びるとともに、近位固定要素７を含む平面によって画定される二つの領域の各々の側に延びる。図示した実施の形態において、近位固定要素７を含む平面の各々の側での、遠位固定要素６の近位固定要素７を含む平面に対する角度は等しい。
Thus, the distal anchoring element 6 extends at an angle with respect to the plane containing the proximal anchoring element 7 and extends on each side of the two regions defined by the plane containing the proximal anchoring element 7. In the illustrated embodiment, at each side of the plane including the proximal fixing element 7, the angle to the plane including the proximal fixing element 7 of the distal fixing element 6 equal arbitrariness.

本体１の厚さが約２ｍｍである場合、本体１は、固定要素６、７の頭部６ａ、７ａのいずれも本体の上に突き出ないように、各遠位穴８及び近位穴９の領域で起伏のある形状をしている（図１０及び１１参照）。これらの起伏部分は図１０及び１１に参照符号１２で示されている。本体１の厚さが３ｍｍである場合、固定要素６、７の頭部６ａ、７ａを本体に皿もみしてもよく、起伏部分を設けなくてもよい。   If the thickness of the main body 1 is about 2 mm, the main body 1 will be in each of the distal holes 8 and the proximal holes 9 so that none of the heads 6a, 7a of the fixing elements 6, 7 protrudes above the main body. It has an undulating shape in the region (see FIGS. 10 and 11). These undulations are indicated by reference numeral 12 in FIGS. When the thickness of the main body 1 is 3 mm, the heads 6a and 7a of the fixing elements 6 and 7 may be seen on the main body, and the undulating portion may not be provided.

本明細書において、「固定要素」という表現は、スクリュー、ピン等を意味し、その横断面は、円形又はその他の形態、例えば三角形、四辺形、若しくはその他の多角形等であり得る。   In this specification, the expression “fixing element” means a screw, a pin, or the like, and its cross section may be circular or other forms such as a triangle, a quadrilateral, or another polygon.

各固定要素６、７は、本発明によれば、橈骨骨折部４の骨片２、３中で固定要素をロックするため及び本体１に固定要素をロックするための、少なくとも１つの固定部１０を有し、それによって、橈骨骨折部の効果的な固定が達成される。   Each fixing element 6, 7 is in accordance with the invention at least one fixing part 10 for locking the fixing element in the bone fragments 2, 3 of the rib fracture 4 and for locking the fixing element to the body 1. So that effective fixation of the rib fracture is achieved.

各固定要素６、７の固定部１０は、目的に適した任意の形状を取り得る。   The fixing part 10 of each fixing element 6, 7 can take any shape suitable for the purpose.

固定部は、例えば、骨片２、３及び細長い本体１に固定要素６、７を螺挿するためにねじ部１０の形態を取り得る。骨片２、３同士の加圧（ｃｏｍｐｒｅｓｓｉｏｎ）及び本体１の骨片への加圧を効果的にするために、固定要素の各先端６ｂ、７ｂに向かってピッチが大きくなるように固定要素６、７の長手方向でピッチの異なるネジ切り部（ｔｈｒｅａｄ）をねじ部１０に設けてもよい。   The fixing part can take the form of a threaded part 10 for screwing the fixing elements 6, 7 into the bone fragments 2, 3 and the elongated body 1, for example. In order to effectively compress the bone pieces 2 and 3 and press the bone pieces of the main body 1, the fixing element 6 is arranged so that the pitch increases toward the distal ends 6 b and 7 b of the fixing element. , 7 may be provided in the threaded portion 10 with a thread having different pitches in the longitudinal direction.

あるいは、固定要素６、７の固定部１０は、２つの別個のねじ部１０ａ及び１０ｂの形態、すなわち、骨片２、３に螺挿されるように構成された第１のねじ部１０ａ及び本体１中に螺挿するように構成された第２のねじ部１０ｂの形態を取り得る。第１の実施の形態のように、２つのねじ部１０ａ、１０ｂのネジ切り部のピッチは変化してよく、その場合、骨片２、３への本体１の所望される加圧を実現するには、骨片２、３と協力する（第１のねじ部１０ａの）ネジ切り部のピッチが、本体１と協力する（第２のねじ部１０ｂの）ネジ切り部のピッチより大きい必要がある。第１のねじ部１０ａが、本体１から更に離れた前記骨片２、３のいずれか（骨片２又は３）とだけ協力する場合、又は固定要素の先端６ｂ、７ｂに向かって第１のねじ部のネジ切り部のピッチが長手方向で大きくなるように変わる場合、骨片同士での加圧も可能である。   Alternatively, the fixing part 10 of the fixing elements 6, 7 is in the form of two separate screw parts 10 a and 10 b, i.e. a first screw part 10 a and a body 1 configured to be screwed into the bone fragments 2, 3. It can take the form of a second threaded portion 10b configured to be screwed therein. As in the first embodiment, the pitch of the threaded portions of the two screw portions 10a, 10b may vary, in which case the desired pressurization of the body 1 against the bone fragments 2, 3 is achieved. For this, the pitch of the threaded portion (of the first screw portion 10a) that cooperates with the bone fragments 2 and 3 needs to be larger than the pitch of the threaded portion (of the second screw portion 10b) that cooperates with the main body 1. is there. If the first threaded portion 10a cooperates only with one of the bone pieces 2, 3 further away from the body 1 (bone piece 2 or 3), or towards the distal end 6b, 7b of the fixation element When the pitch of the threaded portion of the thread portion changes so as to increase in the longitudinal direction, it is possible to apply pressure between bone pieces.

図３〜９のように固定要素６、７が目立つ頭部６ａ、７ａを有する場合、頭部は本体１に螺挿するための前記第２のねじ部１０ｂを構成し得る。   When the fixing elements 6 and 7 have conspicuous heads 6 a and 7 a as shown in FIGS. 3 to 9, the heads can constitute the second screw part 10 b for screwing into the main body 1.

本体１の予め穿設された穴８、９は、ネジ切り部がないように構成されてもよく、その場合、固定要素６、７のネジ切り部１０又はねじ部１０ａ、１０ｂは、それらが本体１に螺挿される時に、本体１中のネジ切り部をスルー（ｃｕｔ）する。   The pre-drilled holes 8, 9 of the body 1 may be configured so that there are no threaded portions, in which case the threaded portions 10 or the threaded portions 10a, 10b of the fixing elements 6, 7 When screwed into the main body 1, the threaded portion in the main body 1 is cut.

あるいは、本体１の予め穿設された穴８、９に、固定要素６、７上のネジ切り部、すなわち固定要素のねじ部１０又は少なくともそれらの第２のねじ部１０ｂに適合されたネジ切り部１１を設けてもよい。   Alternatively, in the pre-drilled holes 8, 9 of the body 1, threaded portions on the fixing elements 6, 7, i.e. threaded portions adapted to the threaded portions 10 of the securing elements or at least their second threaded portions 10b. The part 11 may be provided.

簡潔には、上記器具を用いた骨折部４、特に橈骨５における骨折の固定は、例えば以下のように行われ得る。   Briefly, the fixation of the fracture at the fracture portion 4, particularly the rib 5, using the above-described instrument can be performed as follows, for example.

約４０〜５０ｍｍの１ヶ所の切開又はより短いそれぞれ約２０ｍｍの２ヶ所の切開を骨折部に対して所与の位置で行う。切開を行った後、本体１を橈骨骨折部４に対して正しく設置し、すなわち、本体の長手方向が骨折部を横断方向に横切るように設置し、本体の予め穿設された穴８、９のどれを使用するかを決定する。本体１の位置決定は、例えば、骨折部４の遠位切開部への本体の挿入に、本体の遠位穴８の１つに螺挿される管状要素（不図示）をガイド補助具として用いることで容易になり得、この管状要素は、保持可能であり、橈骨５に沿って本体を動して骨折部の近位切開部に本体を正確に向けるための一種の「ハンドル」として使用可能である。所望であれば、管状要素はその後、遠位固定要素６のための穴を骨片２、３中に形成するためのドリルのガイド補助具としても用いられ得る。あるいは、遠位固定要素は、例えば螺入することで、直接骨片２、３に挿入されてもよい。遠位固定要素６用の穴を骨片２、３に形成するためにドリルを用いる場合、有利には、固定要素を取り付ける前に穴の深さをモニターするために、ドリルに測定用ロッド（不図示）を適用することも可能である。面取りが少なくとも１ヶ所、ここでは少なくとも近位端部１ｂ、しかし好ましくは両方の端部１ａ、１ｂでなされている本体１は、橈骨茎状突起（ｓｔｅｌｏｉｄ）に向かう遠位切開部から骨折部４の近位切開部への橈骨５に沿った本体の動きを容易にする。骨折部４は好適な方法で安定化される。管状要素及びドリルの除去後、第１の遠位固定要素６を、本体１の遠位端部１ａ中に設計された穴８に、例えば螺入することで、挿入する。本体１、又は本体及びドリルで骨片２、３に形成された穴は、一種のドリルガイド又はガイド補助具として機能し、長さを正確に合わせた固定要素６と共に、例えば操作要素を用い、本体への固定要素のねじ状固定部１０の螺入を続けるか固定要素の固定部１０の第２のねじ部１０ｂを本体に螺入開始させることができ、それによって、固定要素は、骨折部４の遠位する橈骨中に導入され、骨折部を通って骨折部の近位する骨中に進む。螺入は、有利には、固定要素６が橈骨５の固定器具から遠い側の皮質を貫通するまで続けられる。プロセス全体はラジオグラフィーによりモニターされる。螺入中、骨５の長手軸と平行に本体１を維持することが重要である。   A single incision of about 40-50 mm or two shorter incisions of about 20 mm each is made at a given location with respect to the fracture. After the incision is made, the main body 1 is correctly installed with respect to the rib fracture part 4, that is, the main body 1 is installed so that the longitudinal direction of the main body crosses the fracture part in the transverse direction. Decide which one to use. For determining the position of the main body 1, for example, a tubular element (not shown) screwed into one of the distal holes 8 of the main body is used as a guide aid for inserting the main body into the distal incision portion of the fractured portion 4. This tubular element can be held and used as a kind of “handle” for moving the body along the rib 5 and accurately pointing the body to the proximal incision of the fracture. is there. If desired, the tubular element can then also be used as a drill guide aid to form a hole for the distal fixation element 6 in the bone fragments 2,3. Alternatively, the distal fixation element may be inserted directly into the bone fragments 2, 3, for example by screwing. If a drill is used to form a hole for the distal fixation element 6 in the bone fragments 2, 3, it is advantageous to use a measuring rod (on the drill) to monitor the depth of the hole before attaching the fixation element. It is also possible to apply (not shown). The body 1 with at least one chamfer, here at least the proximal end 1b, but preferably at both ends 1a, 1b, is connected to the fracture 4 from the distal incision towards the styloid. Facilitate movement of the body along the rib 5 to the proximal incision. The fracture 4 is stabilized in a suitable manner. After removal of the tubular element and the drill, the first distal fixation element 6 is inserted, for example by screwing into a hole 8 designed in the distal end 1a of the body 1. The hole formed in the bone piece 2 or 3 by the main body 1 or the main body and the drill functions as a kind of drill guide or guide auxiliary tool, and uses, for example, an operation element together with the fixing element 6 whose length is accurately adjusted, The threaded fixing part 10 of the fixing element 10 can be continuously screwed into the main body or the second screw part 10b of the fixing part 10 of the fixing element can be started to be screwed into the main body, whereby the fixing element 4 is introduced into the distal radius and proceeds through the fracture and into the bone proximal to the fracture. The screwing is advantageously continued until the fixing element 6 penetrates the cortex on the side remote from the fixation device of the rib 5. The entire process is monitored by radiography. It is important to maintain the body 1 parallel to the longitudinal axis of the bone 5 during screwing.

橈骨骨折部４の整復及び本体１の近位での調整の後、第１の近位固定要素７が、骨折部４の近位側の橈骨中に導入され、骨折部及び骨折部の遠位側の骨を通って進み、第１の遠位固定要素６と交差する。上記した遠位固定要素６を導入及び固定する手順は実質的に繰り返され、前述したガイド補助具としての管状要素及び橈骨骨折部４の骨片２、３に更なる穴を穿孔するための前述したドリルは用いても用いなくてもよいが、好ましくは、近位固定要素７は橈骨５の固定器具から遠い側の皮質を貫通しない。   After reduction of the radius fracture 4 and adjustment proximal to the body 1, a first proximal fixation element 7 is introduced into the radius proximal to the fracture 4 and the fracture and distal to the fracture It advances through the side bone and intersects the first distal fixation element 6. The procedure for introducing and fixing the distal fixation element 6 described above is substantially repeated, and the above-described tubular element as a guide aid and the above-mentioned for drilling further holes in the bone fragments 2 and 3 of the radius fracture 4. The drill may or may not be used, but preferably the proximal anchoring element 7 does not penetrate the cortex of the rib 5 away from the anchoring device.

第２の遠位固定要素６及び第２の近位固定要素７の、本体１にあるそれらのための好適な穴８及び９へのそれぞれの挿入及び固定並びに橈骨５中への前記固定要素の導入が上記と同じように行われ、その結果、橈骨中の骨折部４が安定に固定される。   Insertion and fixation of the second distal fixation element 6 and the second proximal fixation element 7 into the respective suitable holes 8 and 9 for them in the body 1 and the fixation element in the rib 5 The introduction is performed in the same manner as described above, and as a result, the fracture portion 4 in the rib is stably fixed.

本手術は、手術創の縫合及び包帯により完結する。   The surgery is completed with the surgical wound suture and bandage.

本発明に係る器具を本発明の思想及び目的から逸脱することなく添付の請求項の範囲内で変更及び改変できることは当業者に明らかであろう。したがって、前述のように、器具及びその構成部品の形状及びサイズは器具がどのように使用されるか、すなわち患者が子供であるか大人であるか、患者の解剖学的形態、何個の固定要素が骨折部に対してどの角度で使用すべきか等によって変わり得る。器具の種々の部品に選択される材料も変わり得る。   It will be apparent to those skilled in the art that the instrument according to the present invention can be changed and modified within the scope of the appended claims without departing from the spirit and scope of the invention. Therefore, as mentioned above, the shape and size of the instrument and its components depend on how the instrument is used, i.e. whether the patient is a child or an adult, the patient's anatomy, how many fixations It can vary depending on the angle at which the element should be used with respect to the fracture. The materials selected for the various parts of the instrument can also vary.

Claims (20)

器具が、橈骨骨折部（４）の骨片（２、３）に隣接させる少なくとも１つの本体（１）と、前記骨片を固定するために前記本体にロックされることが意図される固定要素（６、７）を含み、
前記本体（１）が、前記固定要素６用に少なくとも２つの穴（８）を遠位端部（１ａ）に有し、前記固定要素（７）用に少なくとも２つの穴（９）を近位端部（１ｂ）に有する、
橈骨骨折部（４）の骨片（２、３）を内固定するための器具であって、
前記橈骨骨折部（５）の前記骨片（２、３）に前記本体の遠位端部（１ａ）及び近位端部（１ｂ）の穴（８、９）を介して前記骨片に挿入される全ての前記固定要素（６、７）が前記本体の横断方向からみた時に前記橈骨骨折部を横切るように、前記穴（８、９）が前記本体（１）の長手軸（Ｌ）に対して斜めに空いており、
各固定要素（６、７）が、橈骨骨折部（４）の骨片（２、３）中で固定要素をロックするため及び前記本体（１）に前記固定要素をロックするための少なくとも１つの固定部（１０；１０ａ、１０ｂ）を有し、
前記本体（１）の前記近位端部（１ｂ）の前記穴（９）を介して挿入される近位固定要素たる前記固定要素（７）が、一つの平面内に位置するように、前記穴（９）が本体の長手軸（Ｌ）に対して斜めに空いており、
前記本体（１）の前記遠位端部（１ａ）の穴（８）を介して挿入される遠位固定要素たる前記固定要素（６）が前記近位固定要素（７）を含む平面の中に包含されないように、前記穴（８）が前記本体の長手軸（Ｌ）に対して斜めに空いており、
前記遠位固定要素（６）が、前記近位固定要素（７）を含む平面によって画定される二つの領域の各々の側に少なくとも一つずつ以上延在し、そして
前記本体の遠位端部（１ａ）の穴（８）を介して挿入される前記遠位固定要素（６）が、前記本体の近位端部（１ｂ）の穴（９）を介して挿入される前記近位固定要素（７）と交差するように、前記穴（８、９）が前記本体（１）の長手軸（Ｌ）に対して斜めに空いていることを特徴とする、器具。 At least one body (1) adjacent to the bone fragment (2, 3) of the rib fracture (4), and an anchoring element intended to be locked to the body to secure the bone fragment Including (6, 7),
The body (1) has at least two holes (8) at the distal end (1a) for the fixing element 6 and at least two holes (9) for the fixing element (7). At the proximal end (1b),
An instrument for internally fixing the bone fragments (2, 3) of the rib fracture (4),
The said bone pieces through the holes (8, 9) of the distal end portion of the front Stories body bone (2,3) (1a) and a proximal end (1b) of the radial fracture (5) as all of the fixed element to be inserted (6,7) crosses the radial fracture when viewed from the transverse direction of the body, before Kiana (8,9) is the longitudinal axis of said body (1) (L ) Diagonally
Each fixation element (6, 7) has at least one for locking the fixation element in the bone fragment (2, 3) of the rib fracture (4) and for locking the fixation element to the body (1) Having a fixing part (10; 10a, 10b);
Wherein such body the proximal end of (1) the securing element (7) serving as a proximal anchoring element to be inserted through the front Kiana (9) (1b) is located in one plane, before Kiana (9) is open at an angle with respect to the longitudinal axis of the body (L),
Among flat the distal end portion distal fixing element serving said fixing element (6) which is inserted through a hole (8) of (1a) including said proximal fixing elements (7) of said body (1) So that the hole (8) is oblique to the longitudinal axis (L) of the body,
Before Symbol distal fixed element (6) is pre-Symbol proximal extends at least one at least on each side of the two regions defined by a plane including a fixed element (7), and said body wherein the distal end is the distal fixing element (6) which is inserted through a hole (8) of (1a), which is inserted through a hole (9) of the proximal end of said body (1b) so as to intersect with the proximal fixing elements (7), characterized in that the pre Kiana (8,9) is free at an angle with respect to the longitudinal axis (L) of said body (1), the instrument. 前記穴（８、９）が、一つの平面であって、前記本体（１）の長手軸（Ｌ）を含むか、または前記本体（１）の長手軸（Ｌ）に平行であり、且つ前記本体（１）中で共通する平面内に配置されていることを特徴とする、請求項１に記載の器具。 Before Kiana (8,9) is a single plane, or including a longitudinal axis (L) of said body (1), or is parallel to the longitudinal axis (L) of said body (1), and 2. Instrument according to claim 1, characterized in that it is arranged in a common plane in the body (1). 前記遠位固定要素（６）の少なくとも１つ及び前記近位固定要素（７）の少なくとも１つが橈骨骨折部（４）の略中心で交差することを特徴とする、請求項１又は２に記載の器具。   The at least one of the distal fixation element (6) and the at least one of the proximal fixation element (7) intersect at approximately the center of the rib fracture (4). Appliances. 前記本体（１）の前記遠位端部（１ａ）の遠位穴たる前記穴（８）が、前記本体の長手軸（Ｌ）に対して略４５°の角度で斜めに空いており、前記本体の近位端部（１ｂ）の近位穴たる前記穴（９）が前記本体の長手軸に対して略４５〜５０°の角度で斜めに空いていることを特徴とする、請求項１〜３のいずれか一項に記載の器具。 The distal end portion of the main body (1) is distal bore serving before Kiana (8) of (1a), which open obliquely at an angle of approximately 45 ° relative to the longitudinal axis of said body (L), wherein the vacant obliquely at an angle of approximately 45 to 50 ° to the longitudinal axis of the proximal bore serving before Kiana (9) is the body of the proximal end of said body (1b), wherein The instrument according to any one of Items 1 to 3. 前記本体（１）の前記各端部（１ａ、１ｂ）の前記穴（８、９）が前記本体の横断方向から見て互いに略平行に空いていることを特徴とする、請求項１〜４のいずれか一項に記載の器具。 Wherein the respective ends (1a, 1b) of said body (1) is pre Kiana (8,9) of vacant substantially parallel to each other when viewed from the transverse direction of the body, according to claim 1 5. The instrument according to any one of 4 above. 前記遠位固定要素（６）が、前記近位固定要素（７）を含む平面の各々の側で、前記近位固定要素（７）を含む平面に対して同じ角度をなして延びることを特徴とする、請求項１に記載の器具。 Wherein the distal securing element (6), at the proximal fixing elements (7) each side of the plane containing the, said extending at the same angle to the plane including the proximal fixing elements (7) The instrument of claim 1, characterized in that 前記本体（１）の厚さが約３ｍｍであることを特徴とする、請求項１〜６のいずれか一項に記載の器具。 Wherein the thickness of said body (1) is about 3 mm, device according to any one of claims 1-6. 前記本体の厚さが約２ｍｍであり、前記本体が、前記遠位穴（８）又は前記近位穴（９）それぞれの周辺領域で起伏した形状（１２）をしていることを特徴とする、請求項１〜６のいずれか一項に記載の器具。 Has a thickness of about 2mm of the body, said body, said the that an electromotive lay shape (12) at said distal holes (8) or the proximal bore (9) each surrounding region The instrument according to any one of claims 1 to 6. 前記本体（１）がその長手方向に湾曲した形状をしていることを特徴とする、請求項１〜８のいずれか一項に記載の器具。   9. Instrument according to any one of the preceding claims, characterized in that the main body (1) has a shape curved in its longitudinal direction. 前記本体（１）の前記端部（１ａ、１ｂ）の一方又は両方が面取りされていることを特徴とする、請求項１〜９のいずれか一項に記載の器具。   10. Instrument according to any one of the preceding claims, characterized in that one or both of the ends (1a, 1b) of the body (1) are chamfered. 前記各固定要素（６、７）の前記固定部が、前記骨片（２、３）及び前記本体（１）に固定要素を螺挿するためにねじ部（１０）の形態を取ることを特徴とする、請求項１〜１０のいずれか一項に記載の器具。 The fixing part of each fixing element (6, 7) takes the form of a screw part (10) for screwing the fixing element into the bone fragment (2, 3) and the body (1). The instrument according to any one of claims 1 to 10. 前記ねじ部（１０）に、固定要素の先端（６ｂ、７ｂ）に向かってピッチが大きくなるように固定要素の長手方向でピッチが変わるネジ切り部が設けられていることを特徴とする、請求項１１に記載の器具。   The threaded portion (10) is provided with a threaded portion whose pitch changes in the longitudinal direction of the fixing element so that the pitch increases toward the tip (6b, 7b) of the fixing element. Item 11. The instrument according to Item 11. 前記各固定要素（６、７）の前記固定部（１０）が２つの別個のねじ部（１０ａ、１０ｂ）の形態、すなわち、前記骨片（２、３）に螺挿されるように構成された第１のねじ部（１０ａ）及び前記本体（１）に螺挿されるように構成された第２のねじ部（１０ｂ）の形態を取ることを特徴とする、請求項１〜１０のいずれか一項に記載の器具。 The fixing part (10) of each fixing element (6, 7) is configured to be screwed into the bone fragment (2, 3) in the form of two separate screw parts (10a, 10b), ie The first screw part (10a) and the second screw part (10b) configured to be screwed into the main body (1) take the form of any one of claims 1-10. The instrument according to item. 前記２つのねじ部（１０ａ、１０ｂ）の前記ネジ切り部のピッチが、前記骨片（２、３）と協力するネジ切り部のピッチが前記本体（１）と協力するネジ切り部のピッチより大きくなるように変わることを特徴とする、請求項１３に記載の器具。   The pitch of the threaded portion of the two threaded portions (10a, 10b) is larger than the pitch of the threaded portion that cooperates with the main body (1). 14. A device according to claim 13, characterized in that it changes to be larger. 前記固定要素（６、７）の先端（６ｂ、７ｂ）に向かってピッチが大きくなるように、前記第１のねじ部（１０ａ）の前記ネジ切り部のピッチが前記第１のねじ部の長手方向で変わることを特徴とする、請求項１３又は１４に記載の器具。   The pitch of the threaded portion of the first threaded portion (10a) is the length of the first threaded portion so that the pitch increases toward the tip (6b, 7b) of the fixing element (6, 7). 15. Device according to claim 13 or 14, characterized in that it changes in direction. 前記固定要素（６、７）が、それぞれが少なくとも１つの固定部を有するスクリュー又はピンの形態を取ることを特徴とする、請求項１〜１５のいずれか一項に記載の器具。   16. Device according to any one of the preceding claims, characterized in that the fixing elements (6, 7) take the form of screws or pins, each having at least one fixing part. 前記本体（１）の前記穴（８、９）がネジ切り部を有さず、前記固定要素（６、７）が、前記本体に螺挿される時に前記本体のネジ切り部をスルーすることを特徴とする、請求項１１〜１５のいずれか一項に記載の器具。 Before Kiana (8,9) does not have a threaded portion of said body (1), wherein the fixing element (6,7) is to be through the threaded portion of the body when it is screwed to the body A device according to any one of claims 11 to 15, characterized in that 前記本体（１）の前記穴（８、９）が、前記固定要素（６、７）のネジ切り部に適合するネジ切り部（１１）を有することを特徴とする、請求項１１〜１５のいずれか一項に記載の器具。 The front Kiana body (1) (8,9), characterized in that it has compatible threaded portion threaded portion (11) of the fixing element (6,7), according to claim 11 to 15 The instrument according to any one of the above. 前記本体（１）の前記穴（８、９）が、前記橈骨骨折部（４）の前記骨片（２、３）に隣接させる前記本体の位置決定のため及び前記橈骨骨折部（４）の前記骨片（２、３）に前記固定要素（６、７）用の穴を形成するためのドリルのための前記穴に取り付けることができる管状ガイド補助具のネジ切り部に適合したネジ切り部（１１）を有することを特徴とする、請求項１〜１６のいずれか一項に記載の器具。 Said body (1) before Kiana (8,9) is the radius fracture the bone fragments and for the radial fracture of positioning of the body to be adjacent to (2,3) of (4) (4) Threading adapted to a threaded portion of a tubular guide aid that can be attached to the hole for a drill for forming a hole for the fixing element (6, 7) in the bone piece (2, 3) 17. Device according to any one of the preceding claims, characterized in that it comprises a part (11). 前記本体（１）がポリエチレン製であることを特徴とする、請求項１〜１９のいずれか一項に記載の器具。   Device according to any one of the preceding claims, characterized in that the body (1) is made of polyethylene.
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